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General NPI Number Information
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NPI Number | 1619270139
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Entity Type | Organization
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Legal Business Name | CARRIAGE HOUSE OBSTETRICS AND GYNCECOLOGY, LLC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 1570 MIDWAY DR SUITE 1
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City | AMMON
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State | ID
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Zip | 83406-6912
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Country | US
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Telephone | 208-522-2557
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Fax | 208-552-2575
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Provider Business Mailing Address
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Address Line | 1570 MIDWAY DR SUITE 1
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City | AMMON
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State | ID
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Zip | 83406-6912
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Country | US
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Telephone | 208-522-2557
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Fax | 208-552-2575
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Authorized Official
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Title or Position | BILLING
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Name | MRS. KATIE DAVENPORT
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Credential |
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Telephone | 208-520-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | O0578
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License Number State | ID
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